Rocklin Crossfit

Rocklin CrossFit Consult: ______* Powered by: Enrolled: ______

Cycle: ______

Pmt. Option: ______

Cal Fit No: ______

Name: DOB/Age: Phone:

Address: City: Zip:

Parent/guardian: Alt. phone:

Email Address:

Occupation:

Physician Phone:

Insurance provider #:

How did you learn about Rocklin CrossFit?

What school/organization do you play for?

Are you currently a Cal Fit member?

What is your major sport(s)?

 Are you on any medication? yes no

 Do you use an inhaler? yes no

 Are you under care of a physician? yes no

 Are you currently injured? yes no

 Have you been injured in the past? yes no

 Do you have any conditions that we should be aware of? yes no

If you answered yes to any question, briefly explain: Rocklin CrossFit

WAIVERS, RELEASES and AGREEMENTS Express Waiver and Release of Liability

I, ______in consideration of Rocklin CrossFit granting me, or the minor athlete named, permission to participate in the Rocklin CrossFit Training Program, its related events and activities, the undersigned hereby acknowledges and agrees that:

1. The risk from injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN ARISING FROM THE NEGLIGENCE OF Rocklin CrossFit and others, and assume full responsibility for my participation; and I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will bring such to the attention of the nearest Rocklin CrossFit official immediately; and, 3. I for myself or on behalf of the named minor child, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, DEFEND AND HOLD HARMLESS, Rocklin CrossFit, its officers, employees, Independent Contractors, Affiliates, and if applicable, owners and lessors of premises (the “Releasees”) used to conduct Rocklin CrossFit events, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss of damage to my person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW.

I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING BELOW, AND I SIGN FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Photography Release Athletes may on occasion be photographed during training at the Rocklin CrossFit facility. The undersigned hereby consents to the use of these photographs, without compensation, payment or reimbursement, by Rocklin CrossFit on its web site or in commercial capacity or in any materials produced and/or published by Rocklin CrossFit. Training Cycle Agreement The undersigned further acknowledges that training sessions at Rocklin CrossFit must be completed during the training cycle for which they were purchased, and that if an athlete fails to complete all sessions within the allotted time period, sessions may be made up only during the active rest and/or the test week prior to the beginning of the next cycle. Missed sessions may not be credited to subsequent cycles.

Flexible Scheduling Agreement: In order for Rocklin CrossFit to maintain its flexible scheduling policy, attendance and communication are important. I understand that if an athlete will be unable to attend a scheduled training session, that session must be cancelled no later than 6:00 P.M. the previous day. Failure to cancel any scheduled session(s) or more than two (2) late cancellations in any cycle will result in the forfeiture of the training session and/or a $25.00 Late Fee.  Initial Here: _____ Signature and Consent to Waivers, Releases & Agreements To be completed and signed by parent/guardian if applicant is under 18 years of age  I am the participating athlete and am 18 years of age or older.  I am the parent or legal guardian of the participating athlete. I have carefully read this Waiver, Release, and Agreement and fully understand and consent to its terms. I have investigated the risks involved in participation in the training program and fully understand and assume such risks in accordance with this agreement. I am aware that this is a release of liability and a contract between Rocklin CrossFit and myself and sign it of my own free will. Printed Name: Birthdate: Street Address: Phone: City, State & Zip E-mail: Signature: Date: